Today, healthcare workers account for somewhere between 11 and 14% of the overall workforce, replacing manufacturing as the largest category of workers in the United States. Their power, however, pales in comparison to the unionized industrial workforce that preceded them, and whom, for many, it is their job to care for. Where popular narratives of the rise of neoliberalism see this transition as coincidental, Gabriel Winant explains how these two worlds—the post-war industrial economy and the post-industrial service economy–are linked, albeit in an unequal ways. Using the example of Pittsburgh, Winant shows how the modern healthcare system emerged, in many ways, to meet the needs of a de-industrializing economy, taking advantage of the social hierarchies engendered by the American welfare state in the process.

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Gabriel Winant is an Assistant Professor of History at The University of Chicago. He is the author of The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America.